Memory Mondays: Behavioral Changes May Be First Signs of Dementia

Occasional forgetfulness can often be written off as “senior moments,” but consistent changes in behavior may actually be the first signs of dementia.

In recent years, researchers have focused on the ways certain behavioral changes may act as early warnings signs for Alzheimer’s and other forms of dementia. The potential diagnosis is called “mild behavioral impairment,” preceding memory and thinking problems that go hand-in-hand with dementia. Changes like persistent social withdrawal, angry outbursts and anxiety accompany it.

Along with this new diagnosis, a group of neuropsychiatrists and other experts proposed a 34-question checklist. This serves to help identify people at greater risk for Alzheimer’s disease. Some examples of questions include:

– Does she/he no longer care about anything?

– Has the person become more anxious or worried about things that are routine?

– Has she/he become unreasonably or uncharacteristically argumentative?

– Does the person lack the social judgment she/he previously had about what to say or how to behave in public or private?

– Does she/he have unrealistic beliefs about her/his power, wealth or skills?

“I think we do need something like this,” Nina Silverberg, director of the Alzheimer’s Disease Centers program at the National Institute on Aging, told The New York Times. She wasn’t involved in creating the checklist or proposing the new diagnosis, but she asserts years of research have proven Alzheimer’s affects behavior alongside memory.

Under the proposal, the mild behavioral impairment assessment and diagnosis would come before mild cognitive impairment. The latter was established over 10 years ago for those with some cognitive issues but who can still perform most day-to-day tasks.

In fact, identifying major behavioral changes as early signs of dementia is crucial. Full-blown dementia approaches much more quickly when someone has mild cognitive impairment alongside mood or behavior changes. That’s according to Dr. Zahinoor Ismail, a neuropsychiatrist at the University of Calgary and one of the researchers involved with the new diagnosis. Autopsies even show these types of patients had much more brain damage, he noted.

Of course, mood swings as you age aren’t an automatic indicator that dementia is on the horizon. The mild behavioral impairment diagnosis requires symptoms to last for at least six months and be a fundamental change, according to Ismail.

However, some experts worry about such an early-stage diagnosis, suggesting it may result in overdiagnosis. This, in turn, may lead to more brain imaging, more doctor’s visits and more people getting more concerned.

“If it becomes a routine practice, that’s a huge amount of dollars,” said Dr. Kenneth Langa, a professor of internal medicine at the University of Michigan. When the model was proposed in 2016, he recommended further testing of the checklist before common use.

Many who receive a mild cognitive impairment diagnosis typically don’t develop full-blown dementia for 10-plus years, according to Langa. As many as 20% of people have later been qualified as cognitively normal. An even earlier diagnosis could lead to greater lengths of negative anticipation of dementia to actually strike, or concern over nothing at all.

But other experts are more enthusiastic about potential improvements in identifying people at risk.

“We should not be ignoring them, waiting for the cognitive manifestations to appear,” said Dr. Mary Ganguli, a professor of psychiatry, neurology and epidemiology at the University of Pittsburgh. “We may be missing the opportunity.”